腰椎棘突间撑开系统的分类特点及临床应用  

Classification characteristics and clinical application of lumbar interspinous distraction system

作　　者：芦俊峰 王宝东 曹杨[1] Lu Jun-feng;Wang Bao-dong;Cao Yang(First Affiliated Hospital,Harbin Medical University,Harbin 150001,Heilongjiang Province,China)

机构地区：[1]哈尔滨医科大学附属第一医院,黑龙江省哈尔滨市150001

出　　处：《中国组织工程研究》2018年第11期1774-1780,共7页Chinese Journal of Tissue Engineering Research

基　　金：哈尔滨市科学技术局(2013AA3BS016)~~

摘　　要：背景:随着腰椎融合手术并发症增多,及其违背腰椎正常生物力学特点加剧邻椎退变的弊端,使更符合正常腰椎生物力学的腰椎动态固定技术应运而生,腰椎棘突间撑开系统作为腰椎动态固定技术的代表之一,也引起了脊柱外科领域的广泛重视。目的:对当前腰椎棘突间撑开系统研究进展进行综述。方法:第一作者在CNKI数据库、万方数据库以"腰椎,棘突间撑开装置,棘突间撑开系统,生物力学,临床应用,腰椎棘突间撑开系统并发症"进行检索,在PubMed数据库、SpringerLink数据库以"lumbar spine,interspinous process implant,interspinous devices,biomechanics,clinical application,postoperative complications进行检索,采纳近期相关研究文献,排查重复研究,仔细阅读筛选,选取英文文献45篇,中文文献10篇,共计55篇。结果与结论:(1)腰椎撑开系统核心设计理念均为撑开责任节段的棘突间隙并限制其活动,增加椎管及椎间孔面积,降低椎间压力,解除神经压迫,可以一定程度恢复置入节段稳定性,对邻近节段活动度无显著影响,同时能有效的避免因打开椎管对脊髓和神经根产生机械性刺激,替代应用于责任节段或联合应用于融合节段的邻近节段,起到改善临床症状并同时预防邻椎病的发生;(2)腰椎棘突间撑开装置可以有效降低置入节段椎间盘和小关节突应力负荷同时保留相应节段的活动度,但内置物本身和置入节段的上下棘突应力升高,警示有增加棘突骨折及内置物疲劳性断裂的风险;(3)各种腰椎棘突间撑开装置在短、中期随访中均具有良好的临床疗效;(4)腰椎棘突间撑开装置的临床疗效可以与脊柱融合手术相媲美,其于局麻下操作、创伤小、手术时间短、恢复快、住院天数短,术后并发症小,在保留腰椎活动度和预防邻椎病等方面更具优势。但棘突间撑开装置也有不足,如医疗费用高、翻修率高、临床疗效不确�BACKGROUND:With the disadvantages of lumbar fusion surgery complications and adjacent vertebral degeneration aggravating against the normal lumbar biomechanical characteristics,lumbar dynamic fixation technology in line with the normal lumbar biomechanics emerges as the times require.Lumbar interspinous distraction system as a representative of lumbar dynamic fixation technique has attracted extensive attentions of the field of spine surgery.OBJECTIVE:To review the current research progress of lumbar interspinous distraction system.METHODS:The first author retrieved in CNKI database and Wanfang database with the key words of“lumbar interspinous distraction device,interspinous distraction system,biomechanics,clinical application,lumbar interspinous distraction system complications”,and searched PubMed database and SpringerLink database with the key words of“lumbar spine,interspinous process implant,interspinous devices,biomechanics,clinical application,postoperative complications”.Recent studies were included after excluding the repeated studies.Finally,55 studies were included,with 45 English studies and 10 Chinese studies.RESULTS AND CONCLUSION:(1)Lumbar distraction system core design concept was for expanding the interspinous space in the responsible segment and limiting their activities,which increases the spinal canal and foramen area,reduces intervertebral pressure,relieves nerve compression,can recover segmental stability to a certain degree,but does not significantly impact the motion range of adjacent segments.Simultaneously,it effectively avoids mechanical stimulation to the spinal cord and nerve root by opening the vertebral canal,replaces adjacent segments applied to the responsible section or combined application to fusion segments,and improves clinical symptoms and prevents the occurrence of adjacent vertebra disease.(2)Lumbar interspinous distraction device can effectively reduce stress load of intervertebral disc and small articular process,and maintain motion range of the corresponding seg

关 键 词：棘突间撑开装置 骨科植入物 脊柱植入物 腰椎 棘突间撑开系统 生物力学 临床应用 棘突间撑开系统并发症 腰椎 生物力学 内固定器 组织工程 

分 类 号：R318[医药卫生—生物医学工程]